- Disturbance in level of consciousness/attention.
- Cognitive and /or perceptual disturbance – disorientation, hallucinations
- Rapid onset and fluctuating course
- Evidence that cause is medical, substances, or medications
- Day/night reversal may be the first manifestation of delirium in patients who are nearing death
Disturbance in level of consciousness can take 2 main forms:
- Hyperactive Delirium - Agitated, picking at clothes and bed covers, rambling and loud incoherent speech
- Hypoactive Delirium - Quiet, sleepy, little spontaneous movement, soft incoherent speech
Delirium is potentially reversible, global change in cognition and consciousness that is relatively acute in onset (in contrast to dementia, which is relatively chronic in onset.) Terminal delirium (eg. Agitation, restlessness, moaning, groaning associated with other signs of the dying process) is irreversible.
What to do:
- It may be most efficacious to try to treat the delirium rather than search for the underlying cause
- Review and discontinue any medications that may be causing or adding to delirium.
- If medications may be helpful, choose a neuroleptic based on the degree of sedation desired and the risk of side effects (anticholinergic and extrapyramidal)